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CALIFORNIA TUMOR T ISSUE REGISTRY

"ENDOCRINE PATHOLOGY"

Study Cases, Subscription A

February 1999

California Tumor T issue Registry c/o: Department of Pathology a nd Human Anatomy

Loma Linda University School of Medicine 11021 Campus Avenue, AH 335 Lorna Unda, California 92350

(909) 824-4 788 FAX: (909) 478-4188

E-mail: cttr@linkline.com

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Target a udience: Practicing pathologists and paU1ology residents.

Coal: To acquaint the participant witll the histologic features of a variety of benign and

malignant neoplasms and tumor-like conditions.

Objectives: The participant will be able to recognize morphologic features of a variety of benign

and malignant neoplasms and rumor-like conditions and relate those processes to pertinent references in the medicalliferature.

Educa tional methods and media: Review of representative glass slides with associated histories. Feedback on consensus diagnoses from participating pathologists. Listing of selected •·eferences from the medical literature.

Principal faeultv: Weldon K. Builock, MD Donald R. Chase, MD

CM"E Credit: Lorna Liuda Uoivc•·sity School of Medicine designates this continuing medical

education activiiy for up to 2 hours of Category I of the Physician 's Recognition Award of the American Medical Association.

CME crodit is offered lor the subscription Y"il' on ly.

Accreditation: L.oma Linda University School of Medicine is accredited by the Accreditation

Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians.

CONTRIDUTOR: Peter Morris, M.D. CASE NO.1 - FEBRUARY 1999 Santa Barbara, CA

TISSUE FROM: Pancreas ACCESSION 1128388

CLINJCAL ABSTRACT: A 48-year-old female Caucasian female complained of progressive muscle weakness, intermittent

diarrhea and a 14 pound weight loss. CT scan revealed a 4.0 em, partially calci fied, irregu lar mass in the area of the left adrenal. At surgery the mass was found to be arising from the tail of the pancreas.

GROSS PATHOLOGY: The 139 gram specimen consisted of tail of pancreas, spleen, and a 4.5 x 4.2 x 4.0 em neoplastic mass

on the anterior surface of the pancreas at the hilum of spleen. The JlUISS was encapsulated, oval and somewhat nodular, with focal areas of calcification. The cut surface was firm, mottled gray-white and red.

SPECIAL STUDIES: Chromogranin strongly positive Synaptophysin strongly posit ive Neuron specific enolase strongly positive Glucagon positive Amyloid negative Congo Red negative Vimentin rumor negative Alpha- I antitrypsin tumor negative Gastrin, insulin, soilUitostatin and pancreatic polypeptide negative

CONTRIBUTOR: Lorna Linda Pathology Group (kt) Lorna Linda, CA

CASE NO.2 - FEBRUARY 1999

TISSUE FROM: Pancreas ACCESSION #28393

CLINICAL ABSTRACT: This 58-year-old female presented with a four month history of intractable diarrhea. Work-up found a

high vasoactive intestinal peptide level. CT showed a tumor in the tail of the pancreas.

GROSS PATHOLOGY: The 143 gram, 10.0 x 5.1 x 3.5 em portion of pancreas included two adjacent lobular tan masses, one

7.0 x 4.5 x 3.0 em, the other 3.5 x 2.5 x 2.0 em. Both masses were necrotic with areas of hemorrhage.

CONTRIDUTOR: Lorna Lind11 Pat hology G•·oup (kt) Lorna Linda, CA

TISSUE FROM: T hymus

CLINICAL ABSTRACf:

CASE NO. 3 - FEBRUARY 1999

ACCESSION 28044

This 81 -year-old male was found to have an anterior mediastinal mass. This was noted during follow­up for colon carcinoma, resected three years earlier.

GROSS PATH OLOGY: The specimen consisted of a 7.5 x 5.5 x 3.5 em tan ovoid, well-circumscribed mass with a thin fibrous

capsule. The cut surface was homogeneous, soft, tan, without hemorrhage or calcification.

CONTRJBUTOR: Loma Linda Pathology Group (mra) CASE NO. 4 - FEBRUARY 1999 Lorna Linda, CA

T ISSUE FROM: Right adrenal ACCESSION #28392

CLINICAL ABSTRACf: This 38-year-old Black female had a history of virilizing syndrome with bilateral adrenal masses. A left

adrenalectomy was done and the right adrena l mass had been followed conservatively for several years. Recent evidence of enlargement of the right adrenal gland and return of the virilizing syndrome Jed to a right adrenalectomy.

GROSS PATHOLOGY: The adrenal g land was largely replaced by an 80 gram, 7.5 x 5.5 x 4.0 em wel l-circumscribed, red­

brown nodule with faintly lobular, firm, orange-red parenchyma.

CONTRIBUTOR: Roger McFadden, M.D. CASE NO. 5 - FEBRUARY 1999 Stockton, CA

TISSUE FROM: Left adrenal ACCESSION #27950

CLINlCAL ABSTRACf: A 47-year-old male developed abdominal pain. CT showed a large left adrenal mass. There was no

clin ical evidence of hormonal activity.

GROSS PAmOLOGY: The 177 gram, 9.0 x 7.3 x 6.8 em irregularly oval mass was gray to red-tan with a central 5.0 em

hemorrhagic cystic area.

SPECIAL STUDIES: CAM 5.2 Chromogranin NSE Ewings ' marker 0 13

rare positivity posirive positive negative

COl\'TRIBUTOR: Nora Ostr7.ega, M.D. Sylmar, CA

TISSUE FROM: Adrenal

CLINICAL ABSTRACT:

CASE NO.6 - FEBRUARY 1999

ACCESSION #27861

This 33-year-old Hispanic female was found unconscious while at work. Work-up showed a cerebral hemorrhage and malignant hypertension (2401160). CT of the abdomen revealed a 4 em right adrenal mass.

GROSS PATHOLOGY: The specimen consisted of a 7.0 x 5.0 x 2.0 em adipose mass. Sectioni ng revealed normal yellow

adrenal cortex compressed by a red-brown mass.

CONTRIBUTOR: E. R. J ennings, M.D .. CASE NO.7 - FEBRUARY 1999 Long Beach, CA

TiSSUE FROM: Thyroid ACCESSION #12056

CLINICAL ABSTRACT: A 51-year-old male had noticed a lump in the right lobe of the thyroid for about three to four months. Jt

had not increased in size but became slightly tender in the last three-four weeks. A total thyroidectomy was performed.

G ROSS PAmOLOGY: The 15 gram thyroid had a 2.5 em nodule in the right lobe. The nodule was soft with a tan granular cut

surface.

SPECIAL STAINS: Calcitonin Chromogranin

strongly positive trace positive

CONTRIBUTOR: Gary Moekli, M.D. Manchester, NR

TISSUE FROM: Thyroid

CLINICAL ABSTRACT:

CASE NO. 8 - J ANUARY 1999

ACCESSION #28215

This 54-year-old female presented with a large mass in the vicinity of the thyroid.

GROSS PATHOLOGY: The thyroid was removed in multiple fragments. The lefl thyroid lobe included a 7.0 em diameter tan­

gray nodular mass. The right lobe consisted of a 6.0 x 4.0 x 2.0 em multinodular tissue fragment.

SPECIAL STUDIES: CAM 5.2 Synaptophysin Calcitonin Thyroglobulin Chromogranin S-100 LCA

strongly positive positive negative negative negative negative negative

CONTRIBUTOR: Guillermo Acero, M.D. CASE NO. 9 - FEBRUARY 1999 Santa Paula, CA

TISSUE FROM: T hyroid ACCESSJON#26313

CLrNICAL ABSTRACT: This 30-year-old Caucasian male was found to have a non-functioning nodule in the right lobe of his

thyroid gland.

GROSS PATHOLOGY: The 4.0 x 3.5 x 1.8 em nodular thyroid included a 2.3 em gray-brown area with surrounding

hemorrhage.

CONTRIBUTOR: Alexandra I. Reichman, M.D. CASE NO. 10 - FEBRUARY 1999 Marysville, CA

TISSUE FROM: Left thyroid ACCESSION 28450

CLINICAL ABSTRACT: This 47-year-old male had a slowly enlarging mass in the left neck for five months. The area was

somewhat tender and he experienced intermittent hoarseness but had no difficulty swallowing. Physical examination showed a 2 em nodule in the left thyroid as well 3S a 5 em palpable node in the left posterior triangle. Serum calcitonin was 2731 (reference range 0-1 00). There was no personal or family history of endocrine disease.

GROSS PATHOLOGY: The 53 gram, 13.5 x 5.0 x 2.5 em thyroid included a well-demarcated 3.5 x 3.0 x 6.0 em variegated

hemorrhagic light or yell ow-tan mass in the left lobe with only a small residual rim of red thyroid tissue.

SPEC IAL STUDIES: Congo red stain Focal ly positive

CALIFORNIA TUMOR TISSUE REGISTRY

ENDOCRINE PATHOLOGY

Minutes- Subscription A

February 1999

SUGGESTED READING (General Topk5 from Re<e nt Literature) :

A Maligllant Small Cell Twnor in a Child. Four Wrongs Do Not Make a Right. Dehner LP. Am J of Clinic Patho/1998; 662-667.

R~ommendations for the Reporting of Pancreatic Specimens Comaining Malignant Tumors. Jorge Albores­Saavedra, Heff'ess C, Hruban RH, Klimsrra D and Longnecker D. Am J Clin Patho/1999; 304-307.

Ten· Year follow-Up of Ovarian Cancer Patients After Second-Look Laparotomy with Negative Findings. Rubin SC, Randall TC, Armstrong KA, Chi OS, and Hoskins WJ. ObstetandGyneco/ 1999; 93(1):2 1-24.

Differentiating Vulvar lnlrtlepithelial Neoplasia From NonneoplaSiic Epilhelial Disorders. The Toluidine Blue Test. Joura EA, Zeisler H, Alexander L, Sator MO and Mullaucr·Ertl S. J Reprod Med 1998; 43:671.074.

California Tumor Tissue Registry c/o: Department of Pathology and Human Anatomy

Lorna Linda University School of Medicine 11021 Campus Avenue, AH 335 Lorna Linda, California 92350

(909) 824-4788 FAX: (909) 558-0188

E-mai l: cttr@linkline.com

CASE NO. 1, ACCESSION NO. 28388 FEBRUARY 1999

INLAND (Riverside/San Bemw-dino) - Pancreatic endocrine carcinoma (I); Alpha cell twnor (pancreatic adenoma) (!);.Sclerosing carcinoid (I); Olucagonoma (I)

BAKERSFIELD (Central Valley Study Oroupl - Adrenal cortical adenoma with sclerosis BAKERSFIELD {San Joaquin Commtmity Hospjtall - Islet cell twnor ORANGE • Olucagonoma . VENTURA (Unilabl - Pancreatic endocrine neoplasm with hy41inized stroma (2) MONTEREY • Islet cell twnor BAY AREA • Islet cell tumor - glucagonorna (3) LONG BEACH - Carcinoid (5) HAYWARD (St. Rose Hospi!llll - Pancreatic endocrine neoplasm, alpha cell type SAN DIEGO CNaval Medical Center) • Glucagonoma (12) NEVADA (Reno) - Pancreatic Islet celltumoc (glucagono111a) (2) COLORADO (North Colo Medical Ctrl · Pan~Teatic endocrine tumoc (glucagonoma with hyalinized

stroma) TEXAS CTexas Tech Med Hlth Ctrl · Endocrine tumor of pancreas (glucagooorna) IDAHO ClDXl • Glucagonorna NEBRASKA CCreightoo University) • Olucagonoma MICHIGAN (Foote Hospital) • Neuroendocrine (islet cell) tumor, glucagon om a MICHIGAN (St. Mary's Hospital) • Adenocarcinoid twnor MICHIGAN (St. Joseph Mercy Hospital) - Islet tumor (glucagonorna) (2) FLORJDA <Tallahassee) • Hyalinized gluca.gonoma (4} OHIO <McCullough-Hyde Memorial Hospital! • Pancreatic endocrine neoplasm with hyalinized stroma KENTUCKY (Woodbine) - Glucagonoma (2) MARYLAND (Natiooal Mesljcal Center) - Islet cell tumor (glucagonoma) WAS HINTON. D.C. (Walter Reedl • Pancreatic endocrine neoplasm PENNSYLVANIA (Lehigh Valley Hospital\ - Pancreatic endocrine neoplasm (islet cell twnor)-

glucagonoma (I}; G!ucagonoma (I); Alpha cell type of islet cell tumor (1); Islet cell tumor (I) PENNSYL V AN!A (BB Oroup) • Alpha islet cell twnor NEW YORK (Northport) • Olucagoooma NEW JERSEY (Edison) - Pancreatic endocrine neoplasm; possible glucagonoma NEW JERSEY (Summit) - Islet cell tumor (4) MASSACHUSETTS (Berkshire Med Ctr) - Islet cell rumor (glucagoooma) CONNECTICUT (Univ Conn H!th Orl • Sclerosing variant of islet cell neoplasm (? glucagonoma) AUSTRALIA (Sydnev) - Pancreatic endocrine tumour (glucagonoma)

DIAGNOSIS:

PANCREATIC ISLET CELL TUMOR ("GLUCAGONOMA") TS9000,M81520

REFERENCES: Heitz PU, Kasp<.'f M, Polalc JM, c:t ul. Pancrcalic Endocrine Tumors. Immunohistochemical Analysis of 125 Tum<>r$.

H11m Pmho/1981(3); 13:263-271. Kruscman CAN, Knijnenburg G, de !u Riviere G, ct al. MorpholoSY and lmmunohlstochemicol!y-Dclined !Jndocrine

Function ofP1111creatic Islet Cell Tumours. llistopotho/1918(6); 389·399. Mukai K, (Jrouing JC. Greider MH and Rosai J. Retrospc<:tive Srudy of 77 P1111crea1ic Endocrine Tumors Using the

lmmunopen»<idasc Mdhod. Am J Surg PaJho/1982; 6(5);387-399. Rutman E. K!oppel C, Bommer G. Kiehn M, eta!. l'aJlcrrotic Gl~ With and Without Syndrome.

Immunohistochemical Study of S Tumour Cases and Review ofLitcrnture. Virclrcws Arch (Pathol Anal) t980; 388(t):S I·67.

Matias-Cuiu X. RIJT Protooncogcnc Analysis in the Diagnosis of Medullury Thyroid Carcinomn 311d Multiple Endocrine Neoplasia Type 11. (New Gene) Ad1•s Arot Patho/1998; 5(3):196-20! .

CASE NO. 2, ACCESSION NO. 28393 FEBRUARY 1999

INLAND (Riverside/San Bernardino) • Pancreatic YlPoma (3); Atypical =cinoid tumor ( I)

BAKERSFTELD {Central Valley Study Group) • Pancreatic VlPoma BAKERSFTELD (San Joaquin Community Hospital) • Atypical carcinoid tumor

ORANGE • VIPoma VENTURA CUoilab) • YIPoma (2)

MONTEREY - YIPorna BAY AREA - Neuroendocrine carcinoma with YIP syndrome (3)

LONG BEACH • Islet cell tumor (YIPoma) (5) HAYWARD (St. Rose HQ!;pital) - Pancreatic endocrine neoplasm (YlPoma) SAN DIEGO (Naval Meslical Center) • VIPoma ( 12) NEVADA CRenol • Pancreatic islet cell tumor {VIPorna) (2)

COLORA DO (North Colo Medical Ctrl • Malignant pancreatic endocrine tumor (YfPoma) TEXAS (Texas Tech Med Hllh Ctrl • Islet cell tumor (VlPoma) IDAHO (I OX) · VlPoma NEBRASKA CCTeighton Universirv) • VTPoma MICHIGAN (Foote Hospital) · Neuroendocrine (islet cell) tumor

MICHIGAN CSt. Mary's Hospital) • Islet cell tumor MICHIGAN {St. Joseph Mercy Hospitql) • Islet cell tumor {VIPoma) (2)

FLORIDA <Tallahassee) • YIPoma, islet cell tumor (4) OHIO CMcCullough-Hvde Memorial Hospital! • Islet cell carcinoma (pancreatic endocrine neoplasm) KENTUCKY <Woodbine) • YIPoma (2)

MARYLAND (National Medical Center) · Islet cell tumor (VIPoma) WAS HINTON. D.C. (Walter Reed) • Pancreatic endocrine neoplasm (YLPoma) PENNSYLVANIA (Lehigh Valley HOS!!itall - Pancreatic endocrine neoplasm (malignant islet cell tumor)

VIPoma (I); YIPoma (I): YIP producing endocrine tumor of pancreas (I); Islet cell tumor with mitoses. Focus suggestive of vascular invasion seen; cannot rio malignancy (I).

PENNSYL V ANlA CBB Group) · Y1 Poma NEW YORK <Northport) · Malignant (?) VIPoma NEW JERSEY (Edison) - Pancreatic endocrine neoplasm. YIPoma NEW JERSEY CSummi!l • YIPoma (4) MASSACHUSETTS CBerkshire Med Ctrl • Islet cell tumor (VIPoma) CONNECTICUT CUniv Conn I-Illh Ctrl - Islet cell neoplasm, favor islet cell carcinoma AUSTRALIA (Sydney) - Pancreatic endocrine tumor (VlPoma)

DIAGNOSIS:

LOW GRAOE PANCREATIC ENDOCRINE NEOPLASM ("VIPOMA ") T59000, M8240 I

REFERENCF .. S: BloomS, Polak JM, PeM<C AGE. Vasoactive Intestinal PeJ)Iidc and Watery Diarrlloea Syndrome. Lancet 1973: Jul 7.

1(7819):14-16. !!loom SR. Polak JM. Glucagonomas. Vll'omo.s WJd Somatosllltinomas. C/111/n Elrdocrinol Mtlab 1980; 9(2):285·297. Lundguist G. Krause U, I.Ar$son L, Grimelius, et al. A Pana-calic-Polypeptidc-Produein& 1'umor A>sociated with

WOHA S)ndnlme. S<mtdiJGostrotnltro t918; 13(6):715-718. Ohig;>shi •1. lskikawa 0. Tamura Sand Tmaota S. Pan=utic Invasion as the ~c lndiauor of Duodenal

Adcnoaltcinoma Treated by Pmcreatoduodcnec~omy Plu• Extended lyn>phadene<:«>my. Surg 1998; 124(3):SIQ-515.

CASE NO. 3, ACCESSION NO. 28044 FEBRUARY 1999

INLAND (Riverside/San Bernardino) • Thymoma (3); Mixed ? and spindle celllhymoma BAKERSFIELD {Central Valley Study Group) • Lymphocytic thymoma BAKERSFIELD (San Joaquin Commynity Hospital) • Thymoma ORANGE - Thymoma, epithelial cell predominant VENTIJRA {Unilab) • Epithelial1hymoma (2)

MONTEREY • Thymoma BAY AREA · Thymoma{3) LONG BEACH · Thymoma {5) HAYWARD <St. Rose Hospital) - TI1ymoma, mixed cortical and medullary SAN DIEGQ (Naval Medical Center) • Thymoma (12) NEVADA (Reno) - Thymoma {2) COLORADO (North Colo Medical Ctrl·· Thymoma {consider thymic carcinoid; fPX needed) TEXAS crexas Tech Me!l Hlth Ctrl • 111ymoma IDAHO (IDXl - Thymoma NEBRASKA !Creighton University) - Thymoma mixed lymphoepirhelial type with capsular invasion MICHIGAN (Foote Hospital) · Mixed medullary and cortical thymoma (Muller-Hermelink) MICHIGAN !St. Mary's Hospital} • Thymoma MICHIGAN {St. Joseph Mercy Hospital) - Thymoma, mixed type {2) FLORJQA (Tallahassee) • Thymoma (4)

OfllO {McCullou!!h-Hvde Memorial Hospital) - Th)'fOid adenoma KENTUCKY (Woodbine> - Thymoma with gland formatioo (2) MARYLAND (National Medical Center) - Thymoma (mixed & spindle cell) (10); Mixed thymoma and

carcinoid (3) WASHINTON. D.C. (Walter Reed) - Invasive thymoma PENNSYLVANIA CLehjgh Valley Hosoitall · Thymoma {3); Thymoma vs thymic carcinoid PENNSYLVANIA <BB Group) • Spindle cell thymoma ? minimal invasive NEW YORK (NorthP9Jl) • Lymphoepithelial thymoma, spindle cell type, minimally invasive NEW JERSEY (Edison) - Neuroendocrine carcinoma/atypical carcinoid) NEW JERSEY {Summit) · Thymoma {2); Thymic carcinoid (2)

MASSACHUSETTS !Berkshire Med Ctrl - Thymoma (5); vs neuroendocrine carcinoma (I) CONNECTICUT CUnjv Conn Hlth Crr) • Thymoma, mixed lymphocytic and epithelial ? hyperplasia AUSTRALIA (Sydney) • Invasive thymoma (low grnde malignant)

DIAGNOSIS:

THYMOMA T98000, M85800

REFERENCES: SeiJO<S TH. Thacl:ray AC on<l i"homfl"''l AD. Tumor.s of the Th)tnUS. A Re•icw of88 ()peralion ~ Thorax 1967;

22(J):t93-220. Rosai J ond Levine GO. Tumors of the 11tymus. Atla., of Tumor Pathowgy. 2"' Series, FIISCicle 13, Washington D.C., Gripp S, Hilgers K, Rcinhrud W, Schmitt G. Thymoma. l'rognostic Faao~ rutd Treatment Outcomes. Cancer 1998:

83(8):1495- t503. Suster S. el at. Primtuy Thymic Epithelial Nc:oplasms Showing Combined Fcatw-os of Thymoma and lbymic

Cat.:inoma. A Clinic:opnthologic Studyof22 Cases. Am J SMrg PatlH>/!996; 20(12):1469-t480. Kuo TT. Thymoma. A Study of the PathoiQ&ic Classifie31ion of71 Cases with (;valuation of the Mullcr-Bc:rmcrlink

Systent. Hum Pathol 1993: 24(7):766-771.

CASE NO. 4, ACCESSION NO. 28392 FEBRUARY 1999

INLAND (Riverside/San Bernardino) • Virilizing adrenal cortical adenoma (2); Cortical adenoma, adrenal (2)

BAKERSFIBLD (Central Valley Study Group) • Adrenal cortical adenoma BAKERSFIELD (San Joaquin Communitv Hospital) • Adrenal conical tumor. favor beoigJt ORANGE • Adrenal cortical adenoma VENTURA (Unilab) • Adrenal cortical adenoma (2)

MONTEREY • Adrenal hyperplasia BAY AREA • Adrenocortical tumor. fractional, with virilizing syndrome (3)

LONG BEACH • Adrenal cortical hyperplasia (5) HA YW ARP (St. Rose Hospital) · Adrenal cortical adenoma (virilizing) SAN DIEGO (Naval Medical Center) • Adrenocortical carcinoma (3); Adenoma (6); Adrenocortical

virilizing neoplasm (I) NEVADA (Reno) · Adrenal cortical carcinoma (2)

COLORADO (North Colo Medical Ctrl . Virilizing adrenal neoplasm. probably adenoma TEXAS <Texas T ecl1 Med Hlth Ctr) • Cortical adenoma (adenomatous cortical hyperplasia) IDAHO {IDXl • Adrenal cortical adenoma NEBRASKA (Creighton University) · Virilizing adrenal cortical adenoma MICHIGAN !Foote Hospital) • Adrenal conical adenoma MICHIGAN (St. Marv's Hospital) • Adrenal cortical adenoma MICHIGAN (St. Joseph Mercv Hospital) · Adrenal cortical neoplasm (2)

FLORIDA <Tallahassee) • Adrenal cortical adenoma (4) OHIO <McCullough-Hyde Memorial Hospital) • Adrenogenital syndrome and cortical adenoma KENTUCKY CWoodbjnel • Adrenal cort.ical neoplasm with virilization (2) MARYLAND <National Medical Center) • Adrenal adenoma WASHINTON. D.C. (Walter Reed) • Adrenal neoplasm suspicious for adrenal carcinoma PENNSYLVANTA (Lehigh Valley Hospital} • Adrenal cortical neopla.sm (adenoma) - virilizing (I );

Adrenal cortical adenoma (I); Nodular cortical hyperplasia (I); Adrenal cortical tumor- favor adenoma. l'fo sigJtificant mitotic activity, no necrosis, no broad fibrous bands. Capsule not well seen in sect.ion ( I)

PENNSYL V AmA ffiB Group) • Adenocortical adenoma with virilization NEW YORK (Northport) • Adrenal cortical adenoma NEW JE.RSEY (Ed.iscnl • Adrenocortical adenoma with adrenogeoital syndrome NEW JERSEY (Summit) . Virilizing adrenal cortical adenoma (2); Cortical adenoma (2) MASSACHUSETTS (Berkshire Med Ctrl • Adrenal cortical adenoma CONNECTICUT (Unjv Coon Hlth Ctrl · Adrenal cortical virilizing neoplasm consistent with adenoma AUSTRALIA CSV!Iney) • Adrenal conic tumour

DIAGNOSIS:

ADRENAL CORTICAL ADENOMA (VIRI LIZING) 1'93000, M83700

REFERENCES: Week EE Jr .. Shaliton U llJld J<alejs 1.. Testosterone Secreting Adrenal Adenoma Under Gonudolropin Control. N F.ng J

Med 1973; 289(15):767-no. Busam KJ, Iversen K, Coplan KA, Old LJ. et al. lrnmunorcctivity for AIOJ. an Antibody to Mclan·A (Mart· I), in

Adrenocorti¢lll and Other Steroid Tumors. Am J Surg Patho/1998; 22(1 ):$7-63. Shimshi M. ROlls F, Goodman A. et ol. Virilizing Adrenocortical Tumor Superimposed on Adrenooorticul llyperplll8ill.

AmJ Mwl992; 93:338-342. Del Gaudio A. Del Gandio G·A. ViriJi>jng Adn:nocorticaJ Tumon in Adult Women. Repon of 10 Patients. 2 of Whom

Each Had a Tumor Secreting Only Tcstooterone. Cancer 1?93(3); 72(6): 1997-2003.

CASE NO. S. ACCESSION NO. 27950

INLAND {Riverside/San Bernardino) • Pheochromocytoma (4)

BAKERSFIELD (Central Volley Study Group} · Adrenal cortical carcinoma BAKERSFIELD (San Joaquin Community Hospital) • Pheochromocytoma ORANGE • Pheochromocytoma VENTURA CUnilabl • Pheochromocytoma (2)

MONTEREY · Adrenal cortical carcinoma BAY A REA • Paraganglioma/pheochromocytoma (3) LONG BEACH • Paraganglioma {3); Pheochromocytoma (2)

HAYWARD (SL Rose Hosoitall • Pheochromocytoma SAN DIEGO (Naval Medical Center) • Pheochromocytoma ( 12) NEVADA CRenol · Pheochromocytoma (2) COLORADO (North Colo Mes!icgl Ctrl ·• Pheochromocytoma IE ){AS ITexas Tech Med Hllh Ctrl • Pheochromocytoma IDAHO (£0)() • Pheochromocytoma/paraganglioma ? NEBRASKA (Creighton Universjtvl • Pheochromocytoma MICHIGAN (Foote Hospital) • Atypical carcinoid MJCHIGAN (St. Mary's Hospital) • Adrenal cortical carcinoma MICHIGAN (SL Joseph Mercy HO!S!!itall · Pheochromocytoma (2) FLORIDA <Tallahassee) • Pheochromocytoma {3); l'arag)lnglioma {I) OHIO (McCullough·Hvde Memorial Hospital) • Pheochromocytoma KENTUCKY (Woodbine) · Pheochromocytoma {2) MARYLAND (National Medical Center) • Pheochromocytoma W ASHlNTON. D.C. (Walter Reed) • Pheochromocytoma PI,NNSVL VANTA (Lehigh valley Hospital) · Pheochromocytoma { 4) PEHNSVL VANIA CBB Group) • Paraganglioma (2); Pheochromocytoma (2)

NEW YORK (Northoortl • Adrenal cortical carcinoma NEW JERSEY (Edisool · Adrenocortical carcinoma

FEBRUARVI 999

NEW JERSEY (Summit) . Non-functioning pheochromocytoma (3); Adrenal cortical carcinoma (I) MASSACHUSETTS (Berkshjre Med Ctrl • Mixed pheochromocytoma/Ganglioneuroma {5) vs

pheochromocytoma ( I) CONNECTICUT (Univ Conn Hllh Ctrl • Pheochromocytoma AUSTRALIA (Sydney) • Pheochromocytoma

DIAGNOSIS:

PffilOCBROMOCVTOMA T93000, M87000

REF!lRENCES: Kr11nc NK. C~nically Unsuspected Pheochromocytomas. E:<periene<o 01 I lenry Ford Hospital and a Review of the

Litcrtllure. Arch Intern Med 1989; 146:54-57. St. John SMG and Sheps SO. Prcvalcnc;e of Clinically Unsuspected l'hcochromoc:ytoma. Review of a 5(}. Year Autopsy

Series. Mayo Clin Proc 1981; 56:354-360. Medeiros W. WolfBC, Balogh K lind Fcdennwt M. Adrenal Phcocl1romocytomQ A Clinicopathologic Review of 60

C(l.o;cs. Hum Patho/1985; 16:580·589. Ramsuy JA, Asa SL, van Nostrand A IV. ct al. Lipid Dege.ncmtion in Pheochromoc}tomas Mimicking Adrcnw Cortical

Tumors. Am J Surg Patho/1981: 11:480-486. Keiser HR. Doppman n., Robertson CN, Linehan WM, ct al. Oiag1>05iS, Localizatioo and Management of

PhcochromOC)1oma. In: l.ack EE, eel. Pathology of the AdrUIOI Glands. New York: Chun:hill Uvinpton 1990; 237-255.

CASE NO. 6, ACCESSTON NO. 27861

INLAND (Riverside/San Bernardino\ - Pheochromocytoma (4) BAKERSFfELD (Central Valley Studv Group) - Adrenal cortical carcinoma BAKERSFIELD (San Joaquin Community Hospital) - Pheochromocytoma ORANGE - Pheochromocytoma VENTURA CUni lab) - Pheochromocytoma (2) MONTEREY - Pheochromocytoma BAY AREA - Pheochromocytoma (3) LONG BEACH - Pheochromocytoma (5) HA YW ARP (St. Rose Hosoita!l - Pheochromocytoma SAN DIEGO (Naval Medical Center) - Pheochromocytoma {12) NEVADA (Reno) - Pheochromocytoma (2) COLORADO (Norib Colo Medical Ctr) - Pheochromocytoma TEXAS <Texas Tech Med Hlth Ctr\ - Pheochromocytoma IDAHO ODXl • Pheochromocytoma NEBRASKA (Creighton University) - Pheochromocytoma MICHIGAN (Foote Hospital) • Pheochromocytoma MICHIGAN (St. Mary's Hospital\ - Pheochromocytoma MICHIGAN (St. Joseph Mercv Hospital) - Pheochromocytoma (2)

FLORIDA (Tallahassee) • Pheochromocytoma (4) OHIO CMcCulloush-Hyde Memorial HOSPital) - Pheochromocytoma KENTUCKY CWocdbine) • Composite pheochromocytoma (2) MARYLAND (National Medicnl Center) - Pheochromocytoma WASHlNTON. D.C. (Walter Reed) - Pheochromocytoma PENNSYLVANIA (Lehigh Valley Hospital) - Pheochromocytoma (4) PENNSYLVANIA CBB Group) - Pheochromocytoma NEW YORK CNorthpor!) • Pheochromocytoma NEW JER5EY (Edison) - Pheochromocytoma NEW JERSEY (Summit) • Pheochromocytoma ( 4) MASSACHUSETTS (Berkshire Med Ctr) • Pheochromocytoma CONNECTICUT CUniv Conn Hlth Ctr) - Pheochromocytoma AUSTRALIA !Sydney) • Pheochromocytoma

DIAGNOSIS:

PHEOCHROMOCYTOMA T93000. M87000

REFERENCES:

FEBRUARY .1999

Correa P and Chen V. Endocrin< Oland Cancer. Concrr 1995: (I Suppl) 75:338-352. (Phcochromoc)toma Adrenal Med11lla pp350·351).

Greene JP. and Guay AT. New l'<'l'spcciives in Pheochromocytoma. Uro/ Cli~ric N ,fm 1989; 16(3):487-503. Shapiro Bond fig t.M. Mana~:Cment ofJ>heochromocycoma. F:ndocrina/ Metab Clinic N Am 1989; 18(2): 443-481. Shcps S.llong NO and Kee GG. J)i8.fpl()Stic E\•aluatlon of PheochromoCytoma. F:ndocrino/.1/etab Clinic N Am 1988:

17(2):397-414. Epelbaum J, el al. Molecular and Phannaoological Characterizatioo of Somatostatin Rcoepcor Subtypes in Adrenlll,

Extraadrcnal. and Malignanl Pheocl\romoe~toma.•. J C/in Endocrinol Mttab 1995; 80(6):1837-1844.

CASE NO. 7, ACCESSION NO. 12056 FEBRUARY 1999

INLAND CRivenide/San Bernardino) - Medullary thyroid carcinoma (4)

BAKERSFIELD (Central Valley Studv Group) - Medullary carcinoma of th~roid BAKERSFfELD CSan Joaquin Community Hospital) - Medullary carcinoma ORANGE - Medullary carcinoma VENTURA CUnilabl - Medullary carcinoma of thyroid (2)

MONTEREY - Medullary carcinoma BAY AREA - Medullary carcinoma of the thyroid (3) LONG BEACH - Medullary carcinoma (5) HAVWARD (St. Rose Hospital) - Medullary carcinoma, thyroid SAN DIEGO (Naval Medical Ct'llterl - Medullary thyroid carcinoma (12)

NEVADA (Reno) - Medullary carcinoma of thyroid (2)

COLORADO (North Colo Medical Ctr)'- Medullary carcinoma of the thyroid TEXAS ITexas Tech Med Hlth Ctrl - Medullary carcinoma IDAHO (IDXl - Medullary carcinoma NEBRASKA CCreightoo University) - Medullary carcinoma of thyroid MICHIGAN Cfoole Hospital) - Medullary carcinoma MICHIGAN (St. Mary's Hospital) - Thyroid medullary carcinoma MTCHJGAN (St. Joseph Mercy Hospital) - Medullary carcinoma (2) FLORIDA (Tallahassee) - Medullary carcinoma (4)

OHIO CMcCullough-RWe Memorial Hosoital) - Medullary carcinoma KENJUCKY (Woodbine) - Medullary carcinoma (2) MARYLAND <National Medical Center) - Medullary carcinoma WASHINTON. D.C. (Walter Reedl - Medullary carcinoma PENNSYLVANIA CLehigh Valley Hospital} - Medullary carcinoma of thyroid (4) PENNSYL VANJA @B Group) - Medullary carcinoma with amyloid NEW YORK (Northport) • Medullary carcinoma NEW JERSEY CEdisonl - Insular carcinoma NEW JERSEY CSwnmitl - Medullary thyroid carcinoma (4) MASSACHUSETIS CBerkshire Med Ctrl • Medullary carcinoma CONNECTICUT CUniv Conn Hlth Ctr) - Medullary carcinoma AUSTRALIA CSydneyl - Medullary carci.norua of thyroid with amyloid stroma

DIAGNOSIS:

MEDULLARY CARCINOMA OF THE THYROID WITH AMYLOID STROMA T96000, M85!03

REFERENCES: Alborc:s-Saavedra J, LiVolsi VA nnd Williams EO. Medullary Carcinoma. Semi11 Diagr~ Parhol 1985; 2:137-146. LiVolsi VA and Feind CR. Incidental Medullary Th)roid Carcinoma in Sporadic Hyperparnthyroidism. An Expw15ion

of the Concept ofCCell Hyperplasia. Am J C/in Patho/1919; 71:595-599. Mendelsohn G, El!l!lc:stoo JC, Wcisburger WR, GoM OS, ct al. Calcitonin and Hiswninase in CCcll H)llCtplosia and

Medullary Thyroid Carcinoma. A Light Mit=oopic and lmmunohistocllcmical Study. Am J Parho/1918; 92:35· 52.

Schmid KW, Fischer.(;olbrie R, Hngn C. Jasani B. ct ul. Chromogranin A and ll wtd Sccreto[lranin n in Mooullary Can:inomasofthcTh)TOid. AmJSurgParho/1981; li:SSI-556.

Sikri KL, Vamdell IM, Hamid QA. et ul. Medullary Carcinoma oftbe Thyroid. An lmmllnOC)1ocbemical and llistochemical Studyof2S Cnscs Using Eigllt Sepal11te Mllrl<ers. Caw:er 1985; 56:2481-2491.

CASE NO. 8, ACCESSION NO. 28215 FEBRUARY 1999

INLAND !Riyeajdc!San B<:m;rdjnol · Parathyroid carcinoma (I): Nodular hyperplasia (I): Medullary card noma ( 1): Poorly differentiated "insul.,... carcinoma (1)

BAKERSFfELD CCenlnll Ynllcy Study Group) • Large cell l)mphoma BAKERSFIELD CSM Joaquin eommupity Hospital} • Neuroendocrine carcinoma O&ANGE • Neuroendocrine c:an:inoma VENTURA Cllnjl;lbl - Small cell undifferentiated carcinoma (2) MONTEREY · Small cell carcinoma flAY AR!.\A • Neuroendocrine carcinoma (3) LONG BEACH • Neuroendocrine carcinoma (S) HAYWARD <St. Rose Hospi!Ail • Small cell aorcinoma of thyroid SAN DIEGO /Nawl Medical Cen!&rl - Medullary thyroid carcinoma (10): MebS!atic neuroendocrine carcinoma (2) NEVADA !Reno\ • Acypical c:on:inoid tumor (I); Malignant carcinoma (I) CO!.QRADQ CNonh Colo MedjCQI Qr) • Neuroendocrine carcinoma (calcitonin free medullary carcinoma ·1) TEXAS <Texa. Tech Mcd Hlth Ctr) • Small ocll (neuroendocrine) carcinoma with plasmuC)toid features IDAHO ODJO • Medullary carcinoma NEBRASKA CCrejshton Vniversityl - Small ocU \'llrianr ofmcdullarycarcinoma ofmyroid MIQ IIGAN (fome Hospjtal) • Poorly ditTer<:ntiatcd carcinoma MICHIGAN (Sl Mury's Hospital) • Anaplastic carcinoma MICHIGAN CSl Joseph Mercy Hospital) · Medullary carcinoma (2) Fl.ORIDA fTalljtha.«ocl • UnditTcteotiaed small cell carcinoma (4) OHIO (McCulloyoh-Hyde Memorial Hospital) • Anaplastic carcinoma KENTUCKY CWoos!binel • Medullary carcinoma (2) MARYI.AND (Nntjona) Medical Center\ - Poorly differentiated careinoma (insular) (II); l'oorlydifferentiatcd

medullary carcinoma (2) WASH!NTON, P-C. (Walrer !!esdl - Carcinoma. favor m<:rastalic oeurocndocrioe carcinoma PENNSYLVANIA Cl&high Valley Hospital) • Medullary carcinoma of thyroid (I); Small cell carcinom> (2);

Neuroendocrine car~inoma- atypical carcinoid (favor) vs. small eel! ( l) PENNSYLVANIA CPB Groop) • Poorly differentiated insular carcinoma N£W YORK (Nonhoonl • Undifferentiated thyroid card noma and Hashimoco'slhyroiditis NEW JERSEY CEdjsonl • Neuroendocrine carcinoma NEW JERSEY <Summjtl • Neuroendocrine carcinoma of thyroid (3); Medullary carcinomn (I) MASSACHUSflT!'S (Berlclhirg M<d Ctr) • Neuroendocrine carcinoma CONNECTICUT C!Jniv Conn Jihh Ctrl • POO!ly differentiated neuroendocrine carcinoma consistent with? medullary

carcinoma AUSTRALIA CSydnev) · Malignant carcinoid tumor (6): Plasmac)torna (2)

DIAGNOSIS:

ANAPLASTIC THYROID CARClNOMA WITH NEUROENDOCRINE FEATURES T96000, M85l03

CONSULTATIONS: Queen £limbeth Hospital-John K.C. Chilll. M.D. "Anaplastic carclno•na (with a small cell and a large cell component)."

REFERENCES: Agruwal S, Rao RS. Parikh DM, Purlkh HK, Borge~ AM, et (~. Histologic Trends in Thyroid Ccnte.-1969-1993. A

CUnioopathologic Analysis of the Relative Proportion of Annpla.<tic Carcinoma of tho Thyroid. J Surg Onco/!996: 63(4):2S1-2SS.

Tan RK. rmlcy RK 3'", Driscoll 0. Baknmjian V. et aL Anaplastic Carcinoma of me Thyroid. A 24-Year Expcrienoe. /lead N•ck 199S.: 17(1):41-47.

MooreD, Ohene-riunko D. <Jarcio Band Chakruharti S. Apoptosis in Thyroid Neoplasms. Relationship with pS3 and bel-2 Expression. Histopotlto/ 199&; 32(1):3S-42.

Kishino T. Waranabe M. KimuraM and Sugawaral. Anti-Proliferative llffcCI ofToremifene and Tarooxifcn on Estrogen Rcceptor-L.addng Anaplastic Thyroid Carcinoma Cell Uncs. Bioi /'harm Bill/ (Japan) 1997: 20(12):12S7-1260.

CASE NO. 9, ACCESSION NO. 26313 FEBRUARY 1999

INLAND (Riverside/San Bemar!ljno) • Papillary carcinoma of thyroid (4)

BAKERSFIELD !Central Valley Study Group) · Papillary carcinoma ofth)Toid BAKERSFIELD CSan Joaquin Cornmunitv Hospital) · Papillary carcinoma ORANGE • Papillary carcinoma VENTURA (Unilabl · Papillary carcinoma of thyroid (2)

MONTEREY • Papillary carcinoma BAY AREA • Papillary carcinoma (3)

LONG BEACH • Papillary carcinoma (5) HAYWARD (St. Rose Hospital) • Papillary carcinoma, thyroid SAN DIEGO fNaV"JI Medical Center) • Papillary carcinoma of thyroid (12) NEVADA IRenol • Papillary carcinoma of thyroid (2) COLORADO !North Colo Medical Ctrl : Papillary carcinoma of thyroid TEXAS <Texas Tech Med Rlth Ctrl • Papillary carcinoma IDAHO C!DXl · Papillary carcinoma NEBRASKA CCreightoo University) - Papillary carcinoma \\oitb Hurthle cell change

MICAIGAN (foote Hospital) • Papillary thyroid carcinoma MICHIGAN 1St. Mary's Hospital) - 'Thyroid papillary carcinoma MICHIGAN (St. Joseph Mercv Hospital) • Cystic papillary carcinoma (2)

FLORIDA CTa!lahassee) - Papillary carcinoma (4) OHIO (McCullough-Hyde Memorial Hospital) - l'llpiUary carcinoma, thyroid KENTUCKY (Woodbine) • Papillary carcinoma (2) MARYLAND !National Medical Center) - Papillary carcinoma WASHINTON. D.C. !Walter Reed) - Papillary carcinoma PENNSYL V ANlA (Lehigh Valley Hospital! • Papillary carcinoma of thyroid (4 )

PENNSYLVANIA (BB Group) • l'llpillary carcinoma of thyroid NEW YORJ< (Northport) - Papillary carcinoma NEW JERSEY !Edison) • Papillary carcinoma of the thyroid NEW JERSEY ISwnmitl • Papillary thyroid carcinoma (3); Hyalinizing trabecular adenoma (I) MASSACHVSErrs (Berkshire Med Ctrl - Papillary carcinoma CONNECTICUT (Univ Conn Hlth Ctrl • Papillary carcinoma with follicular component AUSTRALIA <Sydney) - l'llpillary carcinoma ofthyroid

DIAGNOSIS:

PAPILLARY CARCINOMA, THYROID T961 00. M80503

REFERENCES: Cildy Band Rcosl R. An Expanded Review of Risk Group Definition in Dilfcrcntialed Th)TOid Carcinoma. Surgery

1988; 104(6):947-953. Cunningham Ml', Duda RB, Roorun W, e1 ol. Survival Discriminants for Ditl'crentirued 11>yroid Cancer. Am J Surg

1990; 160(4):344-347. Hay ID, Grant CS, Taylor WF, et al. lpsila!cral Lobeaomy Versus Bilateral Lobar Resection in Papillary Th)TOid

Carcinoma. A Reuospcaive Anal)'1is of Surgical Outcome Using a Novel Prognostic Scoring Sy>tan. SUTg'ry 1987; 102(6}:1088-1095.

Shaha AR and Jaffe BM. Completion Thyroide<:tOm:t-A Critical Appmisal. Surgery 1992; 112(6): 1148·1 152. Shaha AR, Love TR and Shah JP. Intermediate Rlsk Group for Differentiated Carcinoma of Thyroid. Surgery 1994;

116(6): I 036· I 041.

CASE NO. 10, ACCESSION NO. 28450 FEBRUARY 1999

INLAND (Riverside/San Bem!lJ'dinol • Medullary thyroid carcinoma (4) BAKERSFIELD (Central Valley Study Group) • Medullary carcinoma of thyroid BAKERSfiELD (San Joaquin Coromurutv Hospital) · Medullary carcinoma ORANGE • Medullary carcinoma VENTURA Nnilabl . Medullary carcinoma of thyroid (2) MONTEREY • Medullary ca.rcinoma BAY AREA • Medullary carcinoma of the lhyroid (3) LONG BEACH · Medullary carcinoma (5) HAYWARD !St. Rose Hosoirall • Medullary carcinoma, thyroid SAN DIEGO (Nava!Medical Cen!erl • Medullary !hyroid carcinoma (12) NEVADA (Reno) · Medullary carcinoma oflhyroid (2) COLORADO <Nor!h Colo Medjcal C!r) · Medullary carcinoma of !he thyroid TEXAS fTexas Tech Med Hlth C1rl • Medullary carcinoma IDAHO (lOX) • Medullary carcinoma NEBRASKA (Creil!hton Universitvl - Medullary carcinoma of!hyroid MICHIGAN (foote Hospital) • Medullary carcinoma MICHIGAN (St. Marx's Hospjtai) • Thyroid medullary carcinoma MlCHlGAN (St. Joseph Mercy Hospital) • Medullary carcinoma (2) FLORIDA (Tallahassee) • Medullary carcinoma (4) OHIO <McCulloul!h-HWe Memorial Hosoital) • Medullary carcinoma of thyroid KENTUCKY (Woodbine) • Medullmy carcinoma (2) MARYLANQ (National Medical Center) • Medullary carcinoma WASHTNTON. D.C. (Walter Reedl · Medullary carcinoma PENNSYL VA NJA (Lehigh Valley Hospital) • Medullary carcinoma of thyroid ( 4) PENNSYLVANIA (BB Group) • Medullary carcinoma of thyroid NEW YORK (Norlhoor1l • Medullmy carcinoma and Hashimoto's !hyroiditis NEW JERSEY (Edison) · Medullary carcinoma NEW JERSEY (Swnmit) • Medullary thyroid carcinoma (4) MASSACHUSETTS (Berkshire Med Ctrl • Medullary carcinoma CONNECTICUT (Univ Conn Hl!h C!rl • Medullary carcinoma AUSTRALIA CSydney) · Medullary carcinoma of thyroid

DIAGNOSIS:

MEDULLARY CARCINOMA, THYROID T96200, M85 I 03

CONSULTAtiON: Diag11ostic P111hology Medical Group, Inc. Gwen MlllDujian, M.D. "Medullary Carcinoma with lmmunoreaclivity for Calcitonin and CEA.~

REFERENCES: Frac B, Roscnl>l:rg·Bourgjn M, Carllou R Dutricux-Bcrgcr N, et al. Medullary Th}Toid Carcinoma. Search for

Histoloslcal Predictors of Survival (109 PI'Qb:md Ca.les Anal~•is). flwn Pat/rot 1998; 29(!0):1078·1084. Modigliani E. Cohen R, Cnmpo.• JM, cl al. Prognootlc I' actors and for Biochcmic:al Cure in Medullary Thyroid

Carcinoma. Results in 899 POiients. Clin End()Cr/no/ 1998; 48(3}:265·273. llergholm U, Oerptrom Rand Ekbom A. Long Tenn Follc"'"UP ofPMients with Medullary Carcinoma of the Th)TOid.

Cancer 1997; 79(1}:132-138. Alb<J<es-Saavcdra J, et aL Mixed Medullary-Papillary Catcii1Qflla of the 111yroid. A PreviOU5Iy U""""'81'ized Variant of

Th}'Toid C3rcinoma. Hum Patlro/1990; 21(11):115!·1 155. Forrest CH, et ol. Medullary Clli'Cinomo oflhe11lyrold. Ac.-uracyofOiagnosis of Fine-Needle i\spimtion C)'toi08)1.

Cancer 1998; 84(5):295-302.

Addendum

Note: l)pon deeper sectioning of tbi~ case, the patient was found to have two tumors. Phyllodes Tumor and Infiltrating Duct Carcinoma were both presented.

CASE NO. 2, ACCESSION NO. 28140 J ANUARY 1999

INLAND CRi\"ersidt!Sgn Bernardin(!) · Fibroadenoma with introductal au-cinomn in·situ (I); Benign cyl:IOW'OOrna phyllodcs (I); l'hylkldcs tumor, benign (2); Pscudosarcomatosis s1l'OIIlBI h)-pctplasia (I)

BAKER$FIELD ICcotral Valley Study 01911(!) • Phyllndes tumor ORANGE • Active pseudoangjomatous hyperplusin MONTEREY · Infiltrating ductal curcinom11, &rnde 3/3 BAY ARilA • M)'Ofibroblastoma (I): Benign phyllodes wmor (I); Benign fibrous tumor (I) SANTA ROSA: Duct c:an:inoma. invasi-·e ( i): Carcinosarooma (2) LONG BEACH • l'oorly dilfertnti:lled ductal enrcinorna (6) - (In a second set we have case N2 showing only benign

breast tissue SUI!Scstive ofbenian phyllodcs tumor without cvid of mali g. SAN DIEGO (Nayul Modica! Cemerl • Benign l'hyllodes tumor ( I); Borderline phyllodcs tumor (8); Juvenile

fibroadenoma (2) SACRAMENTO OJC Paris) · Phyllodes nunor, lo"' grade HAYWARD 1St Rose Hospi!!!ll • Fibroadenoma (cellular and fibrosing) (6) NEVAPACReno\ • Phyllodcstumor (2) TEXAS (Tsx•< Teclt Regional Aensl Hlth C!rl • 13cnign phyllodes tumor NEIIRASJ(A ICI'doblon Univ) · Fibroadenoma with features of juvenile giant libroadcnoma ILLINOIS <Hinsdale tfosnit!l) • Phyllodes tum<>t (2) MICHIGAt'l !'Onkwood HospjJ!IU • 13cnign phyllodes tumor MICHIGAN fAnn N bo£) • Phyllodcs tumor (2); Phyllod"" tumor , benign (2) FLORIDA ITallahusseel • Benign phyllodes tumor ( 4) FLORIDA (Orlando\ • Fibromalosis of breast OHIO <MeCulloucb·Hyde Memorial Hospjta!) · C)stosarccm~ phyllodes, benign KENUJCKY CBan(j11 HospjJ!ll Ea1tl · Phyllodc.! tumor, histologically benign (2) LOUISIANA CLoujshwa State UniY Med Or) • l' hyllodes tumor, low grade NORTH CAROl.!NA IWNC Palhology Grounl • Ginnt fibroadenoma (juvenile fibroadenoma) (2); Giant (juvenile)

fobroodcooma (2) MARYLAt'ID (Wpgdbinc\ · Cystosarcoma phyllodes, benign ( I); Juvenile fibroadenoma (I) MARYLAND INatjonul Naval Mc<ljcaJ Cent"'"\ • PsC\ldoangiomatous hypcrpi!ISiu (4); Fibroadenoma with Kaposi's

sarcoma ( 4); Kuposi' s saroomn (2) WASHINGTON O.C, (Walter R9Cdl • Juvenile fibroadenoma PENNSyLV ANlA IGonemaucb Memorial Hosphall · Pseudocwgioma1ous stt001al hyp<tplasia PENNSYLVANIA CRB Group) • Phylloides tumor; Cellular Phyllodes tumor PENJ:.ISY.!. VANIA l!.&hig!J Valley Hosoilal) · lntiltnuing ductal can:inoma ( I); Poorly diiTcrcntiuted carcinoma " i th

metuplasia ( I) NEW XORK (Nonhportl · PASH NEW JERSEY (Summjt) • Hamortoma (2); Fibroedeooma with pocudo l~mpllangiomaJous """""(I) MASSACHUSET[S fBerkshire Medical Or\ • Phyllodes tumor (6) vs cellulur fibroadenoma (2) CONN"G[!CI/T <Unjy Conn Hlth Ctr) · Cystosnrooma phyllodes w/angiosurcomn component AUSTRALIA CSvdncy) · Giant fibroadenoma

DIAGNOSIS: Pl:lYLLODES TUMOR AND TNFTLTRATINC DUCT CARCINOMA, BREAST

1'040 10, M90203 T04010, M85003